Welcome to your Gp neelima internal medicine-rhuematology kit 3 13-02-17

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What is the most common cause of septic arthritis in adults?

A 44 year old woman presents with severe bilateral wrist pain, low grade fever, and swelling of the metacarpophalangeal joints. On examination she has decreased range of motion of the wrist joints and swan-neck deformities are seen on both hands along with ulnar deviation. Her rheumatoid factor was positive. Which of the following is NOT a complication of rheumatoid arthritis?

What is the mainstay in the treatment of rheumatoid arthritis in adults?

Antibody study of a patient is shown as follows:

Anti-Centromere High titer
Anti-Sol-70 Not detected
Anti-Pol-I Not detected
Anti-RHP Not detected
Anti-dsDNA Not detected

The disease most strongly suggested by the above antibody study is

Along with gout, colchicine is also beneficial in

A 42 year old woman with lupus erythematous presents with the signs and symptoms of active systemic lupus erythematosus. The physician should do which one of the following, in addition for treatment for acute lupus emergency?

Medication that is beneficial in the treatment of both rheumatoid arthritis and carcinomatous meningitis is which one of the following?

A 56-year-old female with a several month old MI complains of muscle aches and pains and is found to have an elevated creatine phosphokinase (CPK). She is on some medications to reduce recurrence of MI. Which of the following is the likely culprit?

A previously well, 63-year-old hypertensive builder presents with pain, redness and swelling in the right knee, which started 12 hours ago. There is a family history of hypertension and joint problems. What investigation is most important?

Which of the following statements is true immunology of rheumatoid arthritis?

A 52-years-old woman presented with a two week history of malaise and lower limb joint pain, associated with a vasculitic rash over her shins, thighs and buttocks.
Investigations revealed:

Haemoglobin 9.8 g/dL (11.5-16.5)
Platelet count 275 x109 /L (150-400 x109)
Serum creatinine concentration 452 µmol/L (60-110)
Antinuclear antibodies Negative
Antineutrophil cytoplasmic antibodies Negative
Antiglomerular basement membrane antibodies Negative
Dipstix urinalysis Blood +++
Protein +

What is the most likely diagnosis?

A 76 year old male presents with an acute onset of severe pain and swelling of the left wrist following a chest infection which he had two weeks previously. On examination, he had a temperature of 38°C and the left wrist was red, swollen and painful. Which investigation is most appropriate in this patient?

A 64 year old man comes to you with pain swelling of the left great toe at the metatarsophalangeal joint. Examination shows it is erythematosus, warm, swollen, and tender to touch. The patient has a history of diabetes mellitus controlled by diet, and hypertension. His medications include hydrochlorothiazide, 25 mg/day. A CBC and blood chemistry profiles are normal, except for a uric acid level of 9.2 mg/dL (N 3.6-8.5). True statement regarding this situation is

A 41-year-old has acute right knee monoarthritis confirmed to be Gout. He also has a duodenal ulcer. Which of the following would is the best initial treatment for him?

Which one of the following groups is NOT at increased risk for osteoporosis?

A 44-year-old man presents with fatigue, low-grade fever, and weakness, and complains that he can no longer climb up into the cab of his truck. He most likely has

Which of the following statements is NOT true?

A 22-year-old woman suddenly develops total paralysis of the extremities and trunk after eating a large carbohydrate dinner. This has occurred in the past with recurrent attacks of flaccid weakness. Her grandmother also had similar symptoms. Her serum potassium is 2.5 meq/L and her glucose is 120 mg/dl. What is the diagnosis?

A 33 year old woman presents with tender fingertips upon exposure to the cold, arthralgias, difficulty swallowing, and a blanching, erythematous rash on the skin. On examination she has hypertension and fibrosis of the skin. Investigations would most likely show which one of the following?

Which of the following has NOT been shown to be useful in decreasing the severity of osteoporosis in women?

A 36 year old female with a long history of steroid treated lupus presents with severe right hip pain. What is the most likely diagnosis?

All of the following conditions typically affect the lumbar spine, EXCEPT

A 74 year old female is diagnosed with polymyalgia rheumatica. She also complains of a chronic headache. Low dose course of steroids improves her condition dramatically. The most likely diagnosis is

Which one of the following is NOT a common manifestation of progressive systemic sclerosis?

A woman with deformed wrist joints presents for routine evaluation. Hand examination shows decreased range of motion also marked ulnar deviation of the fingers. She has recently had seven dental caries filled. What marker would be specific to identifying the present illness?

47 year old man with hairy cell leukemia presents because of worsening lower extremity pain, especially around the first toe. On examination his right first toe is tender and warm to the touch. The patient is afebrile with splenomegaly and small nodules are noted on the patient´s ear. The metatarsal-phalangeal joint is aspirated. Finding that would be present is which one of the following?

An 80-year-old female suffers a fracture neck of femur following a fall at home. Investigations are normal but her X-ray shows the bones to be rather ´thin´. It is assumed that she is osteoporotic and she is started on alendronate therapy. Which of the following is correct concerning this drug?

A general practice covers a population of 20,000 patients. How many patients with Rheumatoid Arthritis would be expected in this population?

A 17 years old girl presents with a history of polyarthralgia and marked early morning stiffness for 3 months. Her symptoms are relieved by Diclofenac but she is becoming increasingly concerned about her symptoms which appear to be progressing. She is otherwise healthy apart from a history of acne which is well controlled on Minocycline. Her mother has severe rheumatoid arthritis.

ESR 50 mm/hr (0-20)
CRP 100 mg/L (<10)
Rheumatoid factor Negative
ANA Strongly positive (1: 1600)
Anti-dsDNA antibodies Negative
IgG 25 g/L (<15)

What is the most likely cause?

A patient with rheumatoid arthritis who has been taking aspirin present with a normocytic normochromic anemia. All of the following are true about his anemia, except

A 32-year-old pale and unwell lady has chronic pain that changes from day to day, often focusing in the lower back. She wakes up frequently at night, and is unrefreshed in the morning. She also has intermittent constipation and diarrhea. Examination and blood tests are normal but there is tenderness in multiple areas. Diagnose:

A 70-year-old woman presents with Septic arthritis of right ankle with fever of 38.1°C. The right ankle was swollen and very tender with a reduced range of movement. Which of the following will be most helpful?

A 26-year-old female has intermittent diplopia. She says that she chokes on her food and regurgitates it, sometimes through her nose. Physical examination reveals drooping eyelids and bilateral facial muscle weakness without atrophy, deep tendon reflexes are normal. She is most likely suffering from

A 71-year-old has bilateral shouler pain and especially early morning. He has lost one stone in last eight weeks and complains of feeling lethargic with loss of appetite. Investigations revealed a very high ESR (100 mm/hr), Normochromic normocytic anemia and a positive rheumatoid factor. The most likely diagnosis is:

A 53-year-old who had an upper respiratory tract infection presents with progressive weakness in the lower extremities. Deep-tendon reflexes are decreased. A few days later, he develops paralysis of both proximal and distal muscles of both extremities. CSF protein is 108 mg/dl. What is the correct diagnosis?

The group that is at greatest risk for development of inflammatory osteoarthritis of the hands is

Carpal tunnel may result from all of the following EXCEPT

Which is NOT a predisposing factor for herniated disc disease?

A 45 year old woman has had severe joint pain for several years. Initially she was bothered primarily by stiffness, pain, and swelling in her wrists, hands, ankles, and feet. Recently her knees, elbow, and shoulders have become affected. Although she feels better at times, she consistently has an extended period of stiffness during the early morning hours. A biopsy of the synovium of her knee would most likely reveal which of the following?

A 42 year old woman presents with a history of white cyanotic appearing digits when she is exposed to cold which is promptly relieved by heat with a resultant hyperemia. She has normal pulses and has chronic nail and skin changes.
Which of the following is NOT a treatment option for her?

A 35 year old woman presents with an acute exanthem and a "strawberry tongue." The most likely diagnosis is

Antibody study of a patient is shown as follows:

Anti-Centromere High titer
Anti-Sol-70 Not detected
Anti-Pol-I Not detected
Anti-RHP Not detected
Anti-dsDNA Not detected

The disease most strongly suggested by the above antibody study is

A 37 year old woman has symptoms of dry eyes, dry mouth, and difficulty swallowing. Symptoms of vasculitis, nephritis, and polyneuropathy are also present. The serologic test of choice to make the diagnosis is

Which of the following is commonly seen in gout?

Pseudogout is associated with which one of the following?

A 35 year old patient presents because of a painful right wrist. Examination reveals that the toe is exquisitely painful, inflamed, and warm. Similar condition has happened before, generally occurring the morning after a previous evening´s "partying."Joint fluid aspiration would most likely show

A 34 year old single mother of two young children presents with an oral ulcer. Systemic review is significant for fatigue, myalgia, and joint pain. Investigations reveal leucopenia and a high titer of antinuclear antibody. A speckled staining pattern due to anti-Sm is seen with immunofluorescence; urinary protein is elevated. Additional condition that is most likely to be found in this patient is

A 43-year-old had pain and stiffness in her shoulders and wrists for a week worse in the mornings. There was synovitis of both wrists but no proximal muscle tenderness and weakness. ESR was 52 mm/hr. Diagnose:

A woman of 52 years of age has a history of arthritis and swelling for 4 months. On examination, she has a symmetrical inflammation. Movements of hands and feet are painful and swelling is present on both knees, suggesting a diagnosis of rheumatoid arthritis. Regarding her joint disease, which of the following suggest an adverse prognosis?

A 50 year old man has a history of chronic musculoskeletal pain. He has been using frequent doses of Extra-Strength Tylenol with good results. He is concerned about the overdose and asks what his maximum daily dosage of acetaminophen should be. He weight 70 kg (154 lb). You tell him that the most he should take in 24 hours is

A 24 year old woman presents with fever, malaise, generalized arthralgias, and a skin rash, over the nose and malar eminences. The possible finding that has the greatest relative significance in the overall prognosis for the patient is

A woman complains of a severe headache and jaw pain when she chews. Complains of shoulder pain and bilateral wrist weakness are also present. Initial lab tests show an ESR of 75 (normal is less than 30). The most appropriate diagnosis is

A 72 year old woman presents with acute knee arthritis. Radiographs reveal meniscal calcification (Chondrocalcinosis). Synovial fluid analysis reveals weakly positive birefringent rhomboid shaped crystals. The crystals are most likely composed of

The triad of urethritis, uveitis, and arthritis is most commonly found in which of the following disorder?

A woman with swelling of the oral mucosa and dry mouth is found have intense destructive inflammation of the salivary glands and antibodies against the ribonucleoprotein (SS-B). What is also associated with this syndrome?

A 14 year old boy suffers from sporadic episodes of severe muscle weakness. The episodes occur after severe exercise and after large meals rich in carbohydrates and have also occurred in his father and brother. The boy has also had night time attacks, from which he awakes nearly paralyzed Serum electrolyte studies when ordered during one of the patient´s attacks would most likely show

A 10 year old boy has a history of degenerative changes and pain in both shoulders and his left knee. Decreased range of motion is present. A complete blood count with differential is normal, and rheumatoid factor is not present. A sample of urine collected for routine urinalysis turns black upon standing at room temperature. The child is most likely suffering from

Agent that has NOT been found to be useful in the treatment of osteoporosis is

A 35 year old male presents with "sausage" digits involving the distal interphalangeal joints. Skin lesions are also present and his nails are pitted. The patient is most likely suffering from which one of the following?

HLA testing of a 36 year old man with severe left hip pain and whose past history is significant is positive for a a grayish, scaly rash on forehead and hands for several years, but has not required treatment, shows HLA-B27 positivity. HLA-B27 haplotype is strongly associated with which one of the following disease?